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Long way to go for China’s new birth control technique?
The potential of China’s new birth control technique can be assessed only after elaborate trials lasting several years. It can help India. India’s population growth rate is still running high at two per cent.
MEDICAL SCIENTISTS at the Guangzhou Family Planning Technology Centre have perfected a revolutionary and promising technique of male contraception, according to a report in the ‘China Daily’ on Thursday (Nov 15). It is claimed that the ten-minute operation is poised to give men an alternative to the dreaded vasectomy from next year. The Centre has reportedly obtained patents for the technique; its unique feature is that the effect is completely reversible. The procedure consists of placing a tiny tube in the testicle after making a small cut along it. The tube, as big as a standard matchstick, acts like a sort of filter. It blocks the sperm from travelling to the penis. Simply removing the filter- tube in another operation reverses the procedure and re-establishes the natural flow of sperm, claims the Director of the Centre, Dr Wu Weixiong. He elaborated that the procedure took just 10 minutes to perform. "However, it is highly demanding in skill and requires expert doctors," he added.
The Science & Technology Institute of the National Population and Family Planning Commission and the Guangzhou Family Planning S&T Institute have conducted pan-China clinical trials on about 1600 candidates. These included over 500 men from Qingyuan city in Guangdong province. The city apparently obtained 100% success, with no adverse side effect reported. Zhu Jiaming, Vice-President of Guangzhou Sexology Association denies any evidence of impaired sexual health after the tube was removed. Exploding population has been a major bane of underdeveloped countries; as a result, the underdeveloped countries at best remain ‘developing’ countries, unable to become ‘developed’ ones. Unchecked population growth robs them of the fruits of their achievement. China and India together account for close to 40 per cent of the global population. It has been calculated that it would need two planet-earths to sustain the two economies if their citizens are to enjoy the standard of living or per capita consumption of resources, in say 2050, of the kind enjoyed by US citizens CURRENTLY.
Since 1947, the population of India has more than tripled and is expected to cross 1.5 billion in 2030, surpassing China’s headcount. As China has drastically reduced its population growth rate to approx 1.1 per cent, its population would stabilise at a little lower than 1.5 billion by that year. The country is keen to bring down fertility rate to replacement level even faster. In contrast, India’s population growth rate is still running high at two per cent. Demographers expect India’s population to keep soaring until at least 2050, negating any effect of GDP growth on the quality of life of the masses. This shows that India must attach greater importance to birth control than even China.
A study on reproductive health released by WHO (World Health Organization) early in Oct 2007 categorically states, “The only effective way to reduce unwanted pregnancies and abortions is to make contraception widely available.” Of course, there are many conservatives with strong, romanticist ideas about life. They believe, “No form of birth control is about healthcare. It’s about making everyone collaborators with the culture of death.” However, most of them are past their youth, when contraception is critically needed and it is a matter of a person’s individual choice. There are mercifully not many takers for the fundamentalists’ view. ‘Fertility is not a disease’ as far as governments go.
Vasectomy is a permanent and the simplest birth control procedure for men, involving the least complication. It involves removal of a 2-3 cm length of a tiny duct that transports sperms from the testicle, called vas deferens. After the vas is sectioned, the cut ends are sutured or cauterised (burnt or frozen down) to avoid infection. The operation does not affect either the production of male sex hormones (mainly testosterone) or their secretion into the bloodstream. Therefore, there is no loss of libido, erection or orgasm unless one suffers from post-vasectomy pain. In fact, Austrian psychologist Dr Eugen Steinach had documented in the late 18th century that vasoligation (not established as contraception then) enhanced production of testosterone and delayed aging. This resulted in a vasectomy boom in the early 1900s as a form of rejuvenation. The procedure neither requires hospitalization nor full anaesthesia to make the patient unconscious. Only the local area is made numb temporarily.
But, it has one big downside—it is not readily reversible. There are minor variations in the procedure. The modern technique of ‘keyhole’ vasectomy, using a surgical hook to access the scrotum, does away with the dissection knife completely. It usually takes 30-45 minutes to perform in a clinic. There have been successful cases of reversing the procedure, called recannulation. However, the success rate has been quite low and the costs extremely prohibitive. Other problems are psychogenic (imagined) impotence and testicular pain, which have been acknowledged as long-term consequences. Therefore, despite all the simplicity and its irreversibility, even womenfolk are reluctant to let their mates go in for vasectomy. Surgical removal of a similar tube that conducts the egg to the womb in females is preferred as the procedure is usually coupled with delivery at a hospital. In the case of this technique, the female egg produced during menstruation is prevented from growing into a foetus. It is disposed of through the usual tract during the monthly discharge, along with the growth in the inner lining of the womb.
Implantation of small biocompatible devices, similar to what the Chinese doctors have described, has been in existence for many years as an alternative to vasectomy. The US watchdog FDA (Food & Drug Administration) even approved a device named Vasclip in 2002. It involves ligation of the vas deferens to achieve male sterility. According to the medical journal Urology (vide its April 2006 issue), the implant procedure does not require cauterisation or sectioning of the vas, as in vasectomy. But, like vasectomy, it is performed under local anaesthesia in an office-based setting. Clinical trials have found the efficacy with regard to post-operative pain, formation of blood clots and infection rate to be the same as vasectomy. Vasclip procedure averaged just 9 minutes and 6 seconds, according to a Minnesota-based urologist.
While the new Chinese procedure too is claimed to involve less than 10 minutes, albeit with sophisticated equipment and high level of skill, it is not clear how different their implant is from Vasclip. What is of relevance is how the intercepted sperms are to be disposed of. Apart from the ease of reversibility, the reason why no alternative to vasectomy has yet made the grade lies in the handling of the sperm produced. While popular female contraception methods do not drastically interfere with the natural disposal mechanism of the egg, vasectomy (and the Vasclip procedure) drastically changes the method. It is reabsorbed by the body, after breaking it up. This invasion could have long term implications like formation of sperm tumours and it is even feared that it could lead to dementia and depression.
China’s National Food and Drug Administration is currently evaluating the efficacy of the new technique and the claims made. The State health department will mount a campaign for promoting the technique, once the approval is in, Zhu has said. Chinese media has speculated that the approval will come in 2008 itself. While demographists worldwide have been thrilled by the Chinese announcement, urologists and tocologists feel it might be too premature, literally. A doctor practising at Bridge Fertility Centre, London, is quite sceptic about the reversibility claim. Dr Lawrence Shaw quipped, “It would be a great thing and I would welcome it—if it indeed is cent percent reversible.” Dr Neil McClure, Professor of Obstetrics and Gynaecology at Queen’s University in Belfast, has warned: “One of the issues is whether men will still be able to enjoy sex. Also, we need more long term studies on this method, both into rejection by the body and complication rates.”
"When the technique is available, couples will have one more option for birth control and married women do not have to install an IUD (intrauterine device) anymore" is all that can be said of the new (?) procedure as of now. Its potential to revolutionalise birth control initiatives and end the reign of vasectomy as the top birth-control technique addressed at men can be assessed only after elaborate trials lasting several years.
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